Healthcare systems are complex operations in which throughput can be a major factor in the ability to accomplish goals, achieve and maintain financially solvency, and deliver a service level consistent with the expectations of customers or patients and employees, among other things. Delays or bottlenecks can have an adverse impact on throughput and reduce the performance of the healthcare system. Bottle necks can be mitigated via capacity addition and buffer allocation. However, to be able to eliminate a bottleneck, the type, location, and source of the bottleneck must first be identified.
Healthcare systems often have a finite number of assets that can potentially be deployed to mitigate bottlenecks in the system. Assets can include, for example, human capital (e.g., doctors and nurses) and will be referred to generally as resources. When presented with multiple potential bottlenecks, a challenge can be determining which potential bottleneck is most likely to be amenable to amelioration if an additional resource is deployed. Further, when such resources are limited, decisions must be made as to where to deploy the resources to best optimize the performance of the healthcare system. The most optimal resource allocation in a given healthcare system may be different from that in another healthcare system depending on the performance objectives of the healthcare system.
Conventional approaches for capturing information about the state or performance of a given healthcare system very often include measurement errors that can lead to an insurmountable barrier to obtaining the most realistic or true understanding of throughput. If a healthcare system cannot ascertain its real throughput, it will not be able to identify bottlenecks. One common source of measurement error includes employees willingly submitting inaccurate information to minimize what may be perceived to be an excessive workload.
When a patient is discharged from the hospital, while the patient's physical presence within the healthcare facility has ceased, the healthcare facilities' information systems may only become aware of this fact when a transaction consistent with the physical state of the healthcare system is entered into its bed control system. Consequently, any elapsed time between when the patient physically left the building and when the healthcare facilities' information systems are “aware” of this fact are a source of so called “invisible” or imperceptible delays which can and often do have a material impact on throughput and the performance of the healthcare system. For example, the trigger for a member of the healthcare facilities' environmental services team to be dispatched to the vacated room is this entry of the patient disposition in the bed control system. Any time between when the patient left the building and when the corresponding transaction was entered in the bed control system can be considered waste that alone or in conjunction with other waste in the system can have a real and material impact on the performance of the system. For example, if the patient room is not cleaned and “turned over” for the next patient occupant in a reasonable period of time, then a patient that could be moved into the room may still be sitting in the emergency department or the post anesthesia care unit (PACU). If there is a patient in the emergency department occupying a bed when there is no longer a need for that patient to be in that location (for example they have already been admitted to the hospital), then this means that a patient that could potentially be moved into that emergency room bed has to wait longer in the emergency room or that a patient in an ambulance that needs to bring a patient to the emergency room has to be diverted to another hospital. Or in the case of a patient in the PACU that cannot be moved out to a room on the floor, this may result in a patient that is done with surgery that cannot be transported out of the operating room because there is no bed available in the PACU, the impact of which means the operating room cannot be turned over and a patient, anesthesia team, and surgeon that could be operating on another case, cannot begin; essentially the next case that could be put in the operating room in question has to be delayed. The ultimate impact of this ripple effect can be significant. One way to think about it is the net waste in the healthcare system may result in the healthcare facilities' inability to do one or more additional surgical cases, a major source of revenue for healthcare facilities, or may result in the healthcare facilities emergency room wait times to be significantly prolonged, a major service level issue for the hospital and one that can impair the facility's brand, reputation or perception in the market place.